On voiceless days, I feel as if I’m at the end of an uncomfortable, midday summer nap, the kind where my mind is waking up but my body won’t respond. Move, arm. Move, eyelid. They stay motionless, and I know that I have to fight or I will lose myself somewhere between sleeping and waking. Somehow not fighting means not waking up—ever. When I do wake up, I wake up exhausted, tense, confused, wishing I hadn’t closed my eyes at all.
On voiceless days, I am more than alone. I walk to my blue-and-white-painted house, watching new autumn leaves fall to the sidewalk, where they rest within a pattern of leaves that was long ago pressed into wet cement. I think my own thoughts and listen to them echo through my head. I get tired of trying to make people hear me, of repeating myself to constant inquiries of “What?” I stand on the outside of conversations because it’s impossible to insert a barely-whisper into voiceful clamor. I try to telephone my best friend, Terra, but her son thinks no one is on the line. My dad, standing two feet away from me, starts writing me a question on a slip of paper. In my inability to speak, he forgets that I can still hear.
Voiceless, my self seems less than self, like looking in a mirror and barely seeing a reflection. As I walk, I watch the pattern of leaves and sidewalk cracks; I hear the wind turning in the trees above me, the cars on University Avenue splashing through rain puddles; I smell the rainwater as it moves around the tires, the earthiness of smashed worms, and everything cold and soulful. The day says something to me, and I wish I could say something back. I want to laugh out loud, or hum, or say hello to a stranger passing by. But when I tell my vocal cords to move, my voice, my hum, my laugh all come out sounding like a needle sliding forgotten over a vinyl record.
On voiceless days, I read a lot of Whitman. He stands on top of rooftops and shouts:
My voice goes after what my eyes cannot reach,
With the twirl of my tongue I encompass worlds and volumes of worlds.
I wish my yell were so powerful, but it is hardly audible. Whitman says that voices are more than words and tongues. He builds a choir out of a carpenter dressing a plank, a clean-haired Yankee girl working her sewing machine, a prostitute dragging her shawl. “Song of Myself” tells me that there are many ways to sing, to make my voice heard—that just by living, I am saying something. I like to believe that Whitman is right, that even a voiceless girl can encompass worlds in the twirl of her tongue. I try to find other ways of speaking. I write with a new pen, and I smile when someone tells me my writing voice is strong and clear. I cook, trying new ingredients, mixing spices, tasting and stirring. I run my fingers along the strings of my viola, making half steps and counting rests, trying to ignore the missed notes between the moments of solid tone. These are good ways of speaking, but they are not enough. Even when I do construct a resonant phrase or perfect a new recipe or pull my bow solidly to make my viola sing, there is no spontaneity to these voices. I have to write and revise, I have to buy ingredients, I have to rosin my bow. When I can speak, my voice is hardly perfect—I say “hell” instead of “well,” I snort in the middle of a fit of laughter, I babble—but it is immediate and candid. Nothing is hidden, and somehow in my speaking I feel intimately known.
The larynx, the box that builds my imperfect voice, sits where the trachea and the esophagus begin their separate journeys—the esophagus carrying food to the stomach, the trachea carrying air to the lungs. The larynx works like a train switch, making sure the food and air move in the right directions, and it allows for voice production—inside the cartilaginous structure, the vocal cords vibrate, touch, move apart as air passes through to make sound. Wrapped around the outside of the larynx is the thyroid, a butterfly-shaped gland that controls metabolism.
I was barely aware of my thyroid’s existence until a surgeon at London’s Cromwell Hospital showed me a picture that was made by injecting radioactive iodine into my bloodstream and scanning my neck for concentrations of the isotope. I had come to the hospital because of a chronic, but mild, sore throat, fatigue, and an odd fixation that something was wrong. In five weeks, I saw five different doctors, discovered I had asthma, and listened to doctors try to solve my fatigue with questions like “Maybe you’re just bored?” Finally, after numerous blood tests, an ultrasound, and the isotope scan, I was told that I “needed to have surgery on my neck as soon as possible.” The surgeon discussed my options, told me that I might have a thyroid cancer, showed me the picture of my gland, shades of red and green against a black surface. On the left wing of the butterfly gland was an almost-round white spot. The butterfly’s new decoration. When I first saw the picture, I couldn’t feel the lump they said was there, the spot that I could see clearly in pixelated red and green. I’d push on my neck, just where the surgeon had pressed, and I felt nothing. Two weeks later, back home in Utah, just before my surgery to remove the butterfly’s wing, I pressed again. What I hadn’t been able to detect before was now obvious. It was growing and by only lightly pressing, I could feel its edges moving outward. That butterfly wanted to fly. After the surgery, I again felt the spot on the left of my neck. I pushed my fingers deep into a newly carved hollow.
In exchange for the offending half of my thyroid gland, I got a thin, red scar at the base of my neck, what my surgeon optimistically called “an extra smile.” After my new smile healed, I drank a small dose of I-131, iodine’s radioactive isotope—the first step in obliterating the not-yet-offending half of the gland. The thyroid functions on iodine, so the gland took up the radiation, which began to kill the remaining thyroid tissue. As my thyroid gland started to die, my body slowed like an out-of-power windup toy. For months, I slept a large portion of my days, my cheeks swelling up like chipmunks, my eyes continually watering. My body attempted to recover my metabolism by pumping large amounts of thyroid stimulating hormone (TSH) into my bloodstream. After every blood test, I prayed that my TSH levels would be high enough for the next dose of iodine. Finally, they were high enough, and I got to have my toxic cocktail—I-131 mixed with water in a thick, metal container. I sucked all the I-131-rich water up through a plastic straw, and my thyroid gland, desperate to function, grabbed up the iodine. But instead of working again, the gland was utterly destroyed—in an instant.
I sat for the next three days in isolation in a corner room of Utah Valley Hospital, waiting for the radioactive waves emanating from my body to ebb. My door was plastered with red-and-yellow biohazard signs; one was taped to the end of my bed. I thought they should have attached one with a string to my big toe, just in case. The rooms next to me (two on each side) were vacated. I had visitors, but they could stay for only ten minutes at a time. I sat in almost complete silence for those three days, walking back and forth the long room, flipping channels, writing one letter, and reading forty pages of Portrait of a Lady.
I didn’t want to read or watch TV or write. I wanted to talk. When anyone came, I’d try to keep them beyond their allotted ten minutes, even though I’d heard the technician’s geiger counter clicking away at the base of my bed and I knew that I was a biohazard. But I couldn’t take the isolation. I kept talking, reasoning that if I wasn’t dying from drinking the isotope, no one could die from sitting in my room. Terra reasoned the way I did, staying every day well past the end of her lunch hour. Some people were afraid of me and my red and yellow signs, so they hovered in the doorway. Some friends wouldn’t even step next to my bed to hand me the “Congratulations” balloons they’d brought. After they left, I had to retrieve the balloons from the corner where they’d left them floating.
When my days of isolation ended, I was still left in the margins. I had to eat from disposable plates, I couldn’t stand within six feet of anyone, and I couldn’t be near children. One night, I plopped down on the couch beside my sister. She immediately got up from the couch and moved across the room. I looked at her in disbelief and then went into my room to cry. I’m a person who often chooses to be alone, but being forced into the peripheral vision of everyone nearby was too painful. Later my sister sat on the edge of my bed and wrapped her arms around me in spite of the biohazard.
Four months before my cancer diagnosis, while I was in London, I was shocked when my friend Carmen pulled aside the collar of her white shirt to reveal a thick, black line almost blending into her cinnamon skin. I didn’t entirely know what it was for; I knew only that it had something to do with her breast cancer. I remember how I thought it was the line where they would cut away her breast. But I soon got lines of my own, lines that marked borders for the soon-to-come radiation—invisible surgery. My radiation borders made a diamond, from my neck outward in both directions nearly to the joint of my shoulder and back to a center spot just above my breasts. The day they made the map, I pulled down the neck of my sweater to pose for a picture. The marker lines were vivid against my pale skin: four red dots, four xs and connecting lines. The x at the base of my neck was partially rubbed away and looked like a decorative cross, some sort of symbol, something commemorative.
Now all that’s left of my radiation map are four tiny black tattoos, the directional points. Sometimes I connect the dots in the mirror, underneath my fingers, in my head and think about all the things that must have been damaged along with the cancer cells. The radiation beams attacked everything they touched: fast-growing cancer cells, sensitive mucous membranes, developing tissues, my spine.
Carmen writes me about her third round of cancer treatments, two years after mine have finished: “Who would have thought I’d be able to put my breasts on a shelf at night?” Cancer comes without warning, and it always leaves with part of you—your hair, a leg, a breast. Even what the cancer might have left alone gets attacked by the things meant to heal you. Doctors draw battle lines, and there are always unintended casualties. I expected to lose my thyroid gland. It was inevitable, part of the bargain. I had little choice but to accept a nonfunctioning metabolism and a daily dose of synthetic thyroid hormone as the price for my life. But I lost something that I didn’t expect, something my oncologist only hinted at. As he ended his list of possible side effects from my six weeks of external beam radiation, he added casually, “And you may have some hoarseness through this.” Being a relatively new cancer patient, I didn’t know then what I quickly learned. Oncologists are notorious for understatement. His telling me that I might have some hoarseness was like hearing a radio weatherman forecast a chance of showers when you are about to drive into a deluge. My six weeks of radiation turned into eight, nearly nine. A mild sore throat became tears at every attempt to swallow and weeks of drinking Ensure. Tissue irritation became blood and flesh in my handkerchief and excruciatingly painful radiation burns on my neck. Three weeks into radiation, some hoarseness became no voice at all.
My voice stayed away for seven months. Now more than three years out of treatment, my life is a cycle of voice-on, voice-off. The surgery, the radiation, another surgery to correct the effects of the radiation have left my throat a scarred landscape. More surgery would make more scar tissue and more trouble. My trachea is shifted to the left. Along the edges of my larynx, I collect infections—what one doctor calls the human equivalent of a hairball. My throat opens thick and heavy, swollen, patched with white. I’ve seen my vocal cords as they move and try to build sound. I saw them projected onto a television screen, a thin circle of my self caught in the view of a fiber optic lens. “Say, ‘Aaaaaaa,’” the doctor says. “Aaaaaaa,” I reply, dragging out my vowel. Speaking has never been as hard as at this moment, with the unfamiliar heaviness of the scope tugging inside my throat. “Say, ‘Ha, ha.’” “Ha, ha.” I cough, and the picture on the screen is blurred as the vocal cords flap wildly. Watching the pictures, numbed to the hilt, I can still feel the pressure of the thin fiber-optic scope along the back of my nasal passage. My hands clench, my eyes water, I sweat just remembering the pain of the first scope shoved through the same path without any numbing. Sometimes the scope is sent through a nostril, through my sinuses, along the back of my throat. Other times it’s sent directly through my mouth, where I have to focus all my energy on breathing in and out, in and out, so that my gag reflex calms. Now I always demand to be numbed—a piece of cocaine-soaked cotton placed gingerly in my nostrils or an aerosol sprayed copiously into my mouth, its effects climbing up to my forehead and down to my neck.
The hard, narrow, unfamiliar sensation of the scope still follows me around. I can always call it up to make myself feel better by thinking whatever’s present isn’t as bad as that. I hate the scope. Thinking about it makes my teeth ache, makes my nasal passage feel rock hard and singed. I never want to see another ear, nose, and throat doctor again, but I will. I keep letting doctors carve the black scope down into my throat because I hope that one day they’ll bring back my voice for good.
Every day that comes with a voice is a good day, but I know that nothing is certain. I feel as if I’m simply hunkering down, waiting for the enemy. I cling to my voice. I lie in bed and test my voice, singing a few notes, asking a question; I listen for hoarseness the way I sometimes run my fingers along my neck, looking for new cancer. I am always waiting for my voice to stop.
Once, long before the voiceless days, I climbed to the top of St. Paul’s Cathedral. Five hundred and thirty narrow, twisting steps of stone, iron, and wood led me to a view that opened up London’s gray skyline from the Houses of Parliament to the Isle of Dogs. Partway up the arduous climb, I rested for a few minutes in the Whispering Gallery, where I looked through a tall, thick, wrought-iron barrier to see the black-and-white marble pavement stretching out from a wide compass in the center of the cathedral floor. The gallery is watched over by a host of carved saints standing solid within tall alcoves—Jerome, Gregory, Augustine. Leaving my friend at one side of the gallery, I walked along the worn pathway, never sure of my footing on the uneven stone. I sat down on the cold, marble bench running around the edge of the gallery to look up at the dome stretching above me. Conversations buzzed around the walls. There are few secrets here in a place where simple curves become an acoustic miracle. Listening to the echo of the conversations around me, I turned my head toward the graffiti-carved wall and whispered. I could barely hear myself, but as I spoke, the curvature of the wall carried my voice some forty-two meters to my friend, who heard me as if I were speaking right into his ear. If I had foreseen my voiceless days, I wouldn’t have climbed to the top of the dome. I would have stayed in the shadow of the saints and talked, and talked, and talked.